RSS Medical Articles

Acupuncture for Migraine Prevention
Σάβατο, 04.01.2017, 03:00am
Migraine is a common and often disabling neurologic disorder. The 1-year prevalence of migraine in the United States is 18% of women and 6% of men. While migraine preventive medications exist, they are not necessarily effective for all patients and can cause serious adverse effects. Many patients are interested in nonpharmacologic treatment options for migraine. In this issue ofJAMA Internal Medicine, Zhao et al report their findings in a randomized clinical trial (RCT) of acupuncture for migraine prevention. Previous studies of acupuncture for migraine prevention have had somewhat conflicting results, with an RCT published inJAMAshowing no difference between true acupuncture and sham acupuncture.
Moving Forward With Accountable Care Organizations
Σάβατο, 04.01.2017, 03:00am
Our health care system is moving from traditional fee-for-service payment to value-based alternative payment models, such as accountable care organizations (ACOs). With passage of the Medicare Access and CHIP Reauthorization Act, Congress has made clear its intention to accelerate this transition. Because there is strong bipartisan support for these market-based approaches to improving health system performance, it is an opportune time to reflect on what we know about the effects ACOs have had on clinical care and challenges that have been identified.
Undocumented Immigrants and Access to Health Care
Σάβατο, 04.01.2017, 03:00am
The Challenges of Generating Evidence to Support Precision Medicine
Σάβατο, 04.01.2017, 03:00am
Major recent advances in science and technology now enable new kinds of measurements that can characterize an individual’s genes, environment, and behaviors in ways not previously possible. For example, high-throughput genomic analysis and mobile technology can provide large volumes of information that is potentially relevant to prediction of disease and, more importantly, prediction of response to interventions that might improve health. Using this information to precisely target such interventions to persons who are most likely to benefit and least likely to experience adverse effects (ie, precision medicine) could yield major advances in health care (if affordable and scalable to populations) and have a large effect on population health and even health disparities. The National Institutes of Health is making major investments to support this vision.
The Tightrope of Resuming Anticoagulation Therapy After a Bleed
Σάβατο, 04.01.2017, 03:00am
In the absence of randomized clinical trial data to address complex treatment dilemmas when the therapeutic window of a therapy is narrow, the stakes are high, and the risk for harm is substantial, observational studies can help guide decision making. In the case of patients who have atrial fibrillation and an intracranial bleed while receiving anticoagulation therapy, whether one should resume that therapy is one such relatively common scenario. The risk for major bleeding associated with anticoagulation therapy varies from as low as 0.5% per year in low-morbidity populations to as high as 6% per year among patients with prior major bleeds. Given this incidence and the increasing prevalence of atrial fibrillation with an aging population, we can expect this dilemma to become even more common. In this issue ofJAMA Internal Medicine, the observational study by Nielsen et al suggests that resuming warfarin treatment results in a favorable trade-off. However, as with all observational studies, residual confounding may result. Specifically, healthier patients (defined by factors not captured in the multivariate analysis) may have been more likely to resume anticoagulation therapy. Thus, as one engages in a discussion of the risks and benefits of such a high-stakes decision, we think these data are helpful until randomized clinical trials can address the unbiased effects of resuming warfarin therapy. The observed mortality difference in this study is provocative and fills in the evidence gap while supporting the need for a definitive clinical trial.
Gender Disparities in Sponsorship
Σάβατο, 04.01.2017, 03:00am
What do we mean when we talk about the “glass ceiling?” The phrase has been circulating for decades but still refers to the unofficially acknowledged barrier to advancement in a profession, particularly affecting women and minorities.
Biotin-Induced Biochemical Graves Disease
Σάβατο, 04.01.2017, 03:00am
This Teachable Moment examines a case of woman in her 60s whose biotin levels interfered with laboratory assays, suggesting hyperthyroidism, or Graves disease.
A Patient With Hypertrophic Cardiomyopathy Presenting in Cardiac Arrest
Σάβατο, 04.01.2017, 03:00am
A man in his 40s with self-reported hypertrophic cardiomyopathy, hypertension, and obstructive sleep apnea presented in cardiac arrest owing to ventricular tachycardia/fibrillation. He reported feeling unwell on the afternoon of presentation with dizziness and blurry vision, and then abruptly lost consciousness with seizure-like activity. On the arrival of emergency services, he was found to be pulseless with a rhythm of ventricular fibrillation; he was resuscitated with return of spontaneous circulation, intubated, and brought to the emergency department where cooling was initiated. His initial electrocardiogram (ECG) is shown in theFigure, A.
Abnormal Electrocardiogram in a Woman With Atrial Fibrillation
Σάβατο, 04.01.2017, 03:00am
A woman in her 80s with a history of severe symptomatic aortic stenosis and recent transfemoral transcatheter aortic valve replacement (TAVR) presented with a change in mental status characterized by lethargy, blurred vision, nausea, and diarrhea. Her other comorbidities included persistent (chronic) atrial fibrillation (AF), moderate mitral stenosis (peak and mean transvalvular gradients of 12 mm Hg and 5 mm Hg, respectively, with valve area 1.4 cm2) and left intraventricular conduction delay.
Electrocardiography Nondiagnostic ST Elevations With Chest Pain
Σάβατο, 04.01.2017, 03:00am
A man in his 30s with a history of hypertension and occasional tobacco use presented to the emergency department (ED) with several hours of chest pain and nausea. The pain started after eating breakfast and was variably described as constant, sharp, pressurelike, and burning, but was nonexertional, nonpleuritic, and nonreproducible. An electrocardiogram (ECG) was obtained in triage (Figure 1). The first troponin I value was more than 3 times the upper limit of normal at 0.1 ng/mL (normal, ≤0.028 ng/mL [to convert to μg/L, multiply by 1.0]) but still fell within the assay indeterminate range (≤0.3 ng/mL).
  » Hospice Access for Undocumented Immigrants
  » Mentor-Mentee Sponsorship in Male vs Female Recipients
  » Central Nervous System Polypharmacy Among Outpatient Older Adults
  » Medicare Part D Coverage and Cost-Sharing for Inhalers for COPD
  » Changes in Primary Care Access for New Patients With Medicaid and Private Coverage
  » Health Care Among Individuals At Risk for Losing Insurance With Repeal of the ACA
  » States Worse Than Death
  » States Worse Than Death—Reply
  » Considerations for Amending SNAP Regulations
  » Considerations for Amending SNAP Regulations—Reply